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Biomedical subjects

W H Doutré

Publications and source records attributed to W H Doutré.

11 recordsLinked to original sources
PubMed1985

Impact of preceptor counseling on medical resident prescription writing.

A collaborative study was conducted by pharmacists and the clinical preceptor of the otolaryngology outpatient clinic of the University of Texas Medical Branch (UTMB). This study focused on decreasing the percent of legal or procedural errors made by resident physicians. During the study period all prescriptions written by house staff were reviewed by a pharmacist for compliance to previously established criteria. Noncompliant prescriptions were photocopied by the pharmacist and recorded for review by the resident's clinical preceptor. After an 8-week period of baseline data collection, residents were counseled privately by the clinical preceptor and critique on their ability to write a legally and procedurally correct prescription. The residents were made aware of their major deficiencies to enable them to correct the problems. During an unannounced 4-week period, beginning 5 months after preceptor consultation, resident prescription writing was again audited. The result, an overall decrease of 78.5% in noncompliant prescriptions, illustrates that establishing lines of communication between pharmacists and physicians can demonstrably improve health care services. If this change in the quality of prescription writing could be achieved in all of the institution's ambulatory care clinics, an annual conservation of at least $57,000 in pharmacist salaries would be realized.

Drug Prescriptions↗
PubMed1985

Potential use of bar codes to implement automated dispensing quality assurance programs.

Bar code-based systems have automated many counting, tracking, and sorting functions in health care delivery services. We designed and briefly tested the feasibility of a bar code-based dispensing quality assurance system for a hospital outpatient pharmacy. The use of bar codes to verify the identity of the dispensed product required an extra few seconds processing time for each prescription but did not increase markedly the processing time when compared to a control period. In addition to verifying product identity, the system checked the manufacture's expiration date to reduce the risk of delivering outdated medications to the patient. The on-site test period for this feasibility model was relatively short (one week) and no actual dispensing errors were detected. However, when the system was presented with 100 different prescription forms containing 50 randomly sequenced, precontrived dispensing errors, the system identified all medication errors and outdated products. As shown in other studies, bar code-based systems have the potential to capture information not effectively recorded using manual methods. We suggest they should be considered by pharmacists interested in automating inventory management and work flow functions or establishing automated dispensing quality assurance programs.

Computers↗
PubMed1984

The feasibility of barcode-based dispensing quality assurance programs.

A study was conducted to evaluate the feasibility of using barcodes in an outpatient pharmacy quality assurance program. In the first step of this study, adhesive labels containing a barcode representation of the National Drug Code (NDC) identification for the hospital's formulary medications were printed for each stock bottle or drug package used in dispensing. When an outpatient prescription was presented to the pharmacist, a label containing a barcode representation of the NDC identification for the prescribed medication was generated on-line and attached to the back of the prescription form. After the prescription item was filled by the pharmacist, an automated check was performed with a scanning wand by comparing the barcode on the prescription with the previously generated barcode on the stock bottle or drug packaging. A match indicated that the correct medication had been dispensed. Elaborations on this basic automated system for a barcode-based dispensing quality assurance program are suggested.

Computers↗
PubMed1984

Computer skills enhance a hospital pharmacy residency training program.

Hospital pharmacy residents participated in a program designed to introduce them to computer systems useful in pharmacy practice and to provide them with access to a variety of computer resources that could be helpful in completing their residency projects. Using existing computer facilities, various short courses and individual tutorials were employed to train residents in a variety of computer skills. These courses provided a useful vehicle for recent pharmacist graduates to acquire necessary computer skills not obtained during their academic training. Because the program provided residents with the tools needed for the management and analysis of large data sets, a marked increase occurred in the number of residency projects acceptable for publication in peer-reviewed pharmacy journals. Thus, residency projects improved in quality and faculty preceptors were more motivated to get involved in such projects.

Computers↗
PubMed1984

Behaviorally anchored ranking scale versus letters of recommendation for evaluating residency candidates.

A behavioral scale and traditional letters of recommendation were compared as tools for evaluating applicants for a hospital pharmacy residency program. In designing the behaviorally anchored ranking scale (BARS), a list of desirable characteristics of hospital pharmacy residents was compiled and descriptions were written of effective, average, and ineffective performance for these characteristics. Twelve characteristics in three categories (professionalism, special skills, and character attributes) were used. Each person who had written a letter of recommendation for the 1983-84 hospital pharmacy residency program at the University of Texas Medical Branch in Galveston was also asked to complete a BARS form. Pharmacy administrators involved in the resident-selection process used the BARS criteria to evaluate all letters of recommendation; responses on the BARS forms were then analyzed. For 18 applicants, 46 letters of recommendation and 39 BARS forms were completed. Many of the BARS characteristics were not addressed in letters of recommendation. None of the letters commented on leadership quality. Ability to work with others was the BARS characteristic most often mentioned in the letters (58.7%). Of characteristics that were mentioned in both the letters and the BARS, 82.4% were ranked equally in both. Of all the letters and scales, 59% were not in agreement with each other. The BARS provided a clearer picture of the characteristics and qualities of a hospital pharmacy residency candidate than did the letters of recommendation.

Education, Pharmacy↗
PubMed1984

Effect of a triplicate prescription law on prescribing of Schedule II drugs.

Prescribing of Schedule II drugs for outpatients before and after enactment of a triplicate prescription law (TPL) was examined at a 1200-bed teaching hospital in Texas. Four pharmacists reviewed all prescriptions for Schedule II drugs during 1981 (before TPL) and 1982 (after TPL). The name of the drug product, quantity, and prescriber's training classification were recorded. Prescribing of non-Schedule II analgesics was also analyzed. Finally, prescribing by 280 resident physicians was examined for six months before and six months after enactment of TPL. The total number of prescriptions received for Schedule II drugs decreased by 60.4% from 1981 to 1982 (total outpatient prescriptions increased by 12.7%). The number of Schedule II prescriptions received from first-year residents decreased by 44.5%, more than for any other category of prescribers. In each year, nine of the ten most frequently prescribed Schedule II medications were analgesics. The numbers of prescriptions for several non-Schedule II analgesics increased in 1982 at a rate greater than that for all outpatient drugs. The medical residents wrote 2958 Schedule II prescriptions in 1981 and 834 in 1982. At this hospital, a TPL discouraged prescribing of Schedule II drugs.

Drug Prescriptions↗
PubMed1983

Pharmacists' dispensing accuracy in a high-volume outpatient pharmacy service: focus on risk management.

A 12-day peer-review audit was performed in the outpatient pharmacy of a large teaching hospital. The audit process was not masked, that is, the pharmacists were aware of the peer-review evaluation. During the 12-day period, 9394 prescription forms and their corresponding pharmaceutical products were examined manually before being delivered to the patient. A total of 1165 (12.4 percent) dispensing errors were detected, with 141 (1.5 percent) of these considered potentially serious. Seventy-six prescriptions contained two errors and four prescriptions contained three. A linear relationship (r2 = 0.78; p less than 0.001) existed between the number of potentially serious errors and the total number of prescriptions filled. There were no statistically significant differences in the dispensing-error rate for the eight pharmacists audited. There was a trend for the number of pharmacist-hours containing at least one potentially serious dispensing error to increase as the prescription-filling rate accelerated. Outpatient pharmacies with high volumes should set a limit to the number of prescriptions filled by their pharmacists and should experiment with quality assurance systems to reduce dispensing errors and subsequent legal liabilities.

Clinical Competence↗
PubMed1983

Physician noncompliance with prescription-writing requirements.

Prescriptions processed in an outpatient pharmacy department (OPD) were audited retrospectively for physician noncompliance with prescription-writing requirements, and the estimated cost in pharmacist and patient time attributable to the errors made was assessed. During a 14-day period, 7858 prescriptions written by 451 physicians and taken to the OPD of a large teaching hospital were examined. When the patient's name, physician's signature, drug quantity, or directions for use were omitted, patients were asked to return the prescription in person for correction. In a follow-up study, the time spent at the clinic for this purpose was recorded for 50 patients. For another sample of 52 prescriptions corrected by a pharmacist's telephone call to the physician, pharmacist time spent was recorded. Errors were found in 1070 prescriptions. The total number of errors was 1130, for a noncompliance rate of 14.38%. The most frequent errors were ordering of nonformulary drugs and erroneous or unspecified dosage strength. There was no difference in noncompliance among physicians with various levels of training. An average of 25 patients per day were asked to return to the clinic for correction of their prescriptions; more than half did not return to the OPD. For the 50 patients whose return visits were monitored, time spent in the clinic area was 15.0 +/- 9.1 minutes. For the 52 prescriptions corrected by telephone calls to physicians, the pharmacist spent 10.3 +/- 11.0 minutes. Under these study conditions, pharmacists spent 16.3 hours per day correcting prescription errors; if asked to return all unfillable prescriptions, patients would have spent 23.7 hours per day. Pharmacy departments might reduce these time expenditures by conducting periodic reviews of prescription errors and apprising physicians of frequent areas of noncompliance.

Drug Prescriptions↗